Table 1.

Congenital Heart Lesion and Surgical Prioritization during COVID-19.^a

Patient	Emergent (24-48 Hours of Diagnosis When Adequate Resources)	Urgent (Within 1-2 Weeks When Adequate Resources)	High Priority Elective (>2 Weeks When Adequate Resources)
Neonate	Note: Timing for categories will depend on resources available, institutional protocols, and other pending cases
Shunts: right → left
TAPVC/cor triatriatum	Obstructed	Increasing gradient
TGA		<1 week if IVS	2-4 weeks if VSD
Truncus arteriosus			If stable
Tetralogy of Fallot	Spelling/deep cyanosis	Symptomatic
Regurgitant lesions
Ebstein anomaly		Refractory medical management
Obstructive lesions
Coarctation	Shock unable to stabilize on PGE	If able to stabilize on PGE
Critical aortic stenosis	Shock unable to stabilize on PGE	If able to stabilize on PGE
PGE-dependent pulmonary blood flow
PA/IVS		If PDA stent not available
PGE-dependent systemic blood flow
HLHS	Intact, restrictive atrial septum if BAS not available	Case and surgeon dependent	Case and surgeon dependent
Other
Shunt	Shunt thrombosis	Shunt stenosis
Arrhythmias	Symptomatic congenital heart block unable to medically manage/externally pace
ALCAPA	Once medically stabilized
Infant
Shunts: left → right
VSD		Symptomatic CHF on medical management	Failure to thrive
Shunts: right → left
Tetralogy of Fallot		Symptomatic (spells, cyanosis) on medical management
Regurgitant lesions
AVSD			Tri21 with pulmonary overcirculation, consider age of patient to optimize repair, significant regurgitation unable to manage medically
Ebstein anomaly			Increasing right-sided heart failure on medical management
Mitral regurgitation			Symptomatic CHF on medical management
Aortic regurgitation	Acute, hemodynamically unstable		Enlarging LV, decreasing LVEF, symptoms
Obstructive lesions
Valve prosthesis	Thrombosed prosthesis
AS/LVOTO			Decreasing LVEF, symptoms
RVOTO			Decreased RV function
Other
Shunt	Shunt thrombosis	Shunt stenosis
DCM/HF		CHF failing medical management	Failure to thrive
BDCPA candidate			Increasing cyanosis with current shunt, shunt stenosis

Abbreviations: ALCAPA, anomalous left coronary artery from the pulmonary artery; AS, aortic stenosis; AVSD, atrioventricular septal defect; BDCPA, bidirectional cavopulmonary anastomosis ; CHF, congestive heart failure; DCM/HF, dilated cardiomyopathy/heart failure; HLHS, hypoplastic left heart syndrome; LV, left ventricle; LVEF, left ventricular ejection fraction; LVOTO, left ventricular outflow tract obstruction; PA/IVS, pulmonary atresia with intact ventricular septum; PGE, prostaglandin E; RV, right ventricle; RVOTO, right ventricular outflow tract obstruction; TAPVC, total anomalous pulmonary venous connection; TGA, transposition of great artery; VSD, ventricular septal defect.

^a Reproduced from Stephens et al.⁸